The San Diego County Board of Supervisors on Monday extended the local hepatitis A health emergency for another two weeks amid continuing signs the outbreak is slowing down.

The Board is required to review the need for continuing the emergency, which was declared on Sept. 1, every 14 days.

Hepatitis A VaccineImage/National Institute of Diabetes and Digestive and Kidney Diseases

Public health officials told the board in a presentation that here have been 10 cases or fewer reported each week for the past eight weeks. Since the outbreak began on Nov. 22, 2016, 561 cases have been reported, with 378 people requiring hospitalizations and 20 deaths.

“Today’s report shows an overall downward trend in the number of cases,” said Wilma Wooten, M.D., M.P.H., County public health officer. “Maintaining vigilance and continuing our vaccination, sanitation, and education efforts are critical, but combined efforts by the County, community partners, and local municipalities continue to take us in the right direction.”

The County and community partners have given 105,482 vaccinations, including 89,810 to at-risk populations, as part of the County’s vaccination, sanitation and education strategy.

Expanded outreach efforts are underway in targeted communities to make sure the outbreak does not extend into other populations, including:

Four vaccination clinics at the LGBT Center to reach the men who have sex with men community. Four mobile van clinics are also scheduled in Hillcrest during the first two weeks of December

Education and food safety guidelines provided to the faith-based community so they can continue their charity and food distribution efforts over the holidays

Providing vaccinations at the current city camp site and three upcoming tent locations serving the homeless populations

Hepatitis A is most commonly spread from person to person through the fecal-oral route. Symptoms of hepatitis A include jaundice (yellowing of the skin and eyes), fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, and light-colored stools. Symptoms usually appear over a number of days and last less than two months. However, some people can be ill for as long as six months. Hepatitis A can sometimes cause liver failure and even death.